ORLANDO — Inflammatory bowel disease poses many problems for patients and how they live their daily lives. IBD can impact patients’ work and social lives, and it can also impair a basic aspect of life, their nutrition.
At Advances in IBD 2018, Donald Kirby, MD, of the Cleveland Clinic, gave a presentation on some of the major risk factors for malnutrition in patients with IBD — including severity of disease, digestion or absorption problems, and impaired intake — and explained what physicians can do to improve therapeutic approaches that address nutrition in these patients.
Screen for malnutrition
“This is something you’ve really got to think about when you’re taking care of these patients,” Kirby said about malnutrition.
Conducting a thorough physical exam helps identify patients at risk for malnutrition and potential nutritional deficiencies. Accurately recording patients’ height and weight, as well as assessing them using a subjective global assessment and malnutrition universal screening tool are crucial steps that can help determine if a patient needs nutritional support, Kirby said.
It is also important to code for malnutrition to allow for an increase in the length of stay, which can make a big difference in terms of morbidity, mortality and severity index for the patient.
Consider vitamin, mineral deficiencies
“Anemia is the most common extraintestinal manifestation when it comes to [IBD],” Kirby said. “You may have iron deficiency anemia or anemia of chronic disease, they may be mixed.”
Patients also commonly have vitamin B12 deficiency, or deficiencies in folate or zinc. These mineral and vitamin deficiencies could stem from several factors, including intake problems or interactions with medications. Kirby said they could also come down to anatomy.
“So many of our IBD patients have had one or more surgeries,” Kirby said. “We have to think about what is available to do the digesting and the absorbing. ... If you don’t test for [vitamin or mineral deficiencies], you won’t find them.”
Ask about complementary medicine
“Up to 50% – probably closer to 80% – of patients are doing this,” Kirby said. “Most vitamins and minerals actually fit under this because most of those are not FDA regulated.”
Kirby said patients often ask if they should be taking supplements, like fish oil, fiber or curcumin.
“The data is not very good for fish oil per se,” Kirby said. “But tell them they should be eating their fish.”
He added that fiber is probably acceptable if the patient does not have flares or CD strictures.
Learn about IBD diets
“I really encourage you to ask your patients what they’re eating,” Kirby said. “There are lots of patients that are out there very interested in searching the internet and finding all sorts of different diets. ... Patients come in with reams of paper trying to figure out what’s right for them.”
Common diets for patients with IBD include the exclusive enteral nutrition diet, the low-FODMAP diet, specific carbohydrate diet, paleolithic diet and the IBD anti-inflammatory diet.
“It behooves us to learn about diets in IBD, so we can actually tell our patients what to eat,” Kirby said. – by Alex Young
Disclosure: Kirby reports no relevant financial disclosures.